434414780-11-16-2022-07-CC-SYIP-CL92LZ-20221116163021

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414780
Report Date: 11/16/2022
Date Signed: 11/16/2022 04:30:28 PM

Document Has Been Signed on 11/16/2022 04:30 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	STATE PRESCHOOL AT GLEN VIEW		FACILITY NUMBER:	434414780
ADMINISTRATOR:	SHEILA FANNING		FACILITY TYPE:	850
ADDRESS:	475 W 9TH STREET		TELEPHONE:	(669) 205-7960
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	48	CENSUS: 27	DATE:	11/16/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:53 AM
MET WITH:	Beatrice Magdaleno		TIME COMPLETED:	02:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Required-1 Year inspection. LPA met with Olga Barba, Site Supervisor, and explained the reason for the inspection. Early Childhood Administrator, Beatrice Magdaleno, arrived shortly after. Present during today's inspection were 27 children and at least five (5) staff. At 10:04AM and 10:16AM, LPA observed that a child went to the bathroom. There was staff standing at the entrance of the bathroom, however, the curtain was drawn. Therefore, the staff cannot visually supervise children in the restroom. LPA discussed with Beatrice that children need to be supervised at all times including visually. License, notification of parent's rights, and car seat law were observed to be posted. There is a working phone at the facility. LPA reviewed sign in/sign out sheet. LPA observed that there was one child who was not signed in. LPA reminded Beatrice to check that all children are signed in. LPA toured in the inside and outside of the facility. LPA observed that there were containers of disinfectant wipes and a bottle of Lysol cleaning supply in the cabinets, which are accessible to children. Cabinet with Lysol cleaning supply had a latch. LPA discussed about moving Lysol cleaning supply to a shelf that is inaccessible to children. All other cleaning supplies, disinfectant, or other items that could pose a risk to children were observed to be inaccessible. There are toys for children. Furniture and equipment were age appropriate. There is a fully ------------------continues on 809 dated 11/16/2022 page 2-------------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: STATE PRESCHOOL AT GLEN VIEW	FACILITY NUMBER: 434414780
	VISIT DATE: 11/16/2022

NARRATIVE

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charged fire extinguisher and smoke detector. Beatrice stated that there is no carbon monoxide detector at the center and will send proof of purchase and installation to Licensing. The last disaster drill was conducted on 11/16/2022. Beatrice stated that there are no weapons, such as firearms, stored on the premise.

The outdoor area is fenced. Area around play structure have resilient material. Shaded rest area is provided through canopy and building overhang. There were no bodies of water observed during today's inspection.

Facility only provides snacks to children. Kitchen to store snacks were observed to be clean. Menu was observed to be posted. Drinking water is provided through water pitcher and cups.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. LPA observed that C-1's medication was in a ziplock bag, which had the label. The original box was not in the ziplock bag. For IMS information, see PIN 22-02-CCP.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

A copy of the facility roster was obtained during today's inspection. Five (5) children's files were reviewed during today's inspection. The records reviewed include but not limited to physician's report. LPA observed that C-2 had TB test conducted, but the results were not written on the form.

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SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: STATE PRESCHOOL AT GLEN VIEW	FACILITY NUMBER: 434414780
	VISIT DATE: 11/16/2022

NARRATIVE

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Seven (7) staff files were reviewed during today's inspection. The records reviewed include but not limited to education credit, Mandated Reporter training, Health Screening, and TB test. S-1 did not have Health Screening on file. S-2 and S-3 did not have TB test results on file. LPA also discussed with Beatrice about ensuring that all forms are filled out completely and signed. There is at least one staff with a valid CPR/1st Aid, which expires on 10/2023.

Facility is a State Preschool; therefore, the Gilroy School District monitors all criminal record and child abuse index clearance. Beatrice verified that all staff are fingerprint cleared.

Facility will submit the following:
- proof of carbon monoxide detector
- original packaging for C-1's medication
- TB test results for C-2
- S-1's health screening
- S-2's TB test results
- S-3's TB test results
- training on supervision with staff and list of staff who received training
- paperwork for Olga Barba to change her to Site Supervisor

As a result of this inspection, three Type B citations were issued. Exit interview conducted and report was reviewed with Early Childhood Administrator, Beatrice Magdaleno. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/16/2022 04:30 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: STATE PRESCHOOL AT GLEN VIEW	FACILITY NUMBER: 434414780
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/16/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.954

Licensure Requirements

Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/30/2022
	Plan of Correction
1 2 3 4	By POC 11/30/2022, Beatrice stated that they will purchase and install a carbon monoxide detector. Beatrice will send proof to Licensing.

Type B

Section Cited

CCR

101229(a)(1)

Responsibility for Providing Care and Supervision

(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. LPA observed that children went to the restroom and the curtain was drawn, where the staff cannot visually supervise child in the restroom. Staff was standing at the entrance of the restroom.
	POC Due Date: 12/02/2022
	Plan of Correction
1 2 3 4	By POC 12/02/2022, Beatrice stated that she will conduct training with staff regarding supervision. She will send training notes and list of staff who received training to Licensing.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/16/2022 04:30 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: STATE PRESCHOOL AT GLEN VIEW	FACILITY NUMBER: 434414780
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/16/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(g)(1)

Personnel Requirements

(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. S-1 did not have Health Screening. S-2 and S-3 did not have TB test results.
	POC Due Date: 12/16/2022
	Plan of Correction
1 2 3 4	By POC 12/16/2022, Beatrice stated that she will have staff complete Health Screening and TB test and send proof to Licensing.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

LIC809 (FAS) - (06/04)

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